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Step 4 of Your Personal Injury Claim – How do I pay My Doctor?

Categories:Working with an Attorney

Step 3 of our series talks about the importance of medical treatment for your auto accident case. Step 4 is in place to educate you about how, exactly, your medical bills are paid in a personal injury case.

PIP

Florida Law requires Florida drivers to purchase $10,000 in PIP coverage – this is mandatory.  PIP stands for personal injury protection.  PIP is the only auto insurance required by Florida Law.  Basic PIP covers 80% of your medical bills and up to 60% of your lost wages up to a total of $10,000. Because Florida is a no-fault state, no matter who is at fault for the accident, PIP will provide you with easy/instant access to medical care. The beauty of No-Fault (PIP) is you do not have to prove fault to seek treatment.  This avoids delays in treatment.

Florida’s PIP was dramatically overhauled during the 2012 Florida Legislature to become effective in 2013.  To obtain the full benefit of your $10,000 PIP policy, the new PIP law provides that the injured party seek medical treatment from a specific type of medical professional or facility within 14 days from the accident. The new law outlines acceptable providers as:

  • MD (Medical Doctor)
  • Osteopath
  • Dentist
  • Hospitals or facilities that own or is wholly owned by a hospital

Additionally one of the above listed providers must find that you have an emergency medical condition.  Failing the above reduces your PIP benefits to $2500.

The 14 day time limitation & the requirement for a diagnosis of “an emergency medical condition” by a narrow group of specified medical professional poses many challenges.  In many cases you will pay for $10,000 in coverage but may be limited to $2500 in coverage unless you fit the stringent requirements outlined above.  This is patently unfair to the consumer.

Medical Payments Coverage

Medical Payments Coverage is optional coverage on your Auto Policy that pays for medical bills and expenses you incur as a result of an auto accident. Like PIP, this coverage is “no-fault” and will cover you without consideration as to who is at fault.  In most cases Med Pay coverage can be utilized to pay any PIP deductible or PIP co-pays.  If there is still Med Pay Coverage available it will continue to pay your treating doctors and facilities until the coverage is exhausted.  Although Med Pay coverage is helpful to fill the gaps of your PIP deductible or co-pay, there are some drawbacks to Med Pay.  Many Med Pay policies have contractual provisions in the policy of insurance requiring you to pay back monies expended under the Med Pay policy in the event you recover monies from a 3rd party at fault party. This is distinguished form PIP as PIP does not have to be repaid from any recovery.

Health insurance

Most Health Insurance Policies will provide coverage for injuries suffered as a result in an auto accident.  However, this coverage usually kicks in after you have exhausted your PIP & Med Pay coverage.   To summarize up to this point, PIP & Med Pay are primary.  PIP pays 80% of your bills up to a maximum of $10,000. If you have Med Pay coverage it will cover anything PIP doesn’t cover including your PIP deductible and PIP co-pay. Once your PIP & Med Pay coverage is exhausted your health insurance coverage would kick-in.  Your health insurance is secondary.

Letter of Protection (LOP)

In some case your medical bills may exceed Your PIP and Med Pay coverage.  Normally you would look to your health insurance to pick up the cost of your medical care after PIP and Med Pay were exhausted.  If you do not have health insurance what are your options?

Many times a doctor or surgical facility will agree to accept a Letter of Protection from you and your attorney agreeing to pay the doctor and/or surgical facility out of any settlement proceeds.  The LOP is signed by you, your attorney and the doctor. The LOP typically outlines the amount protected and how a Pro-Rata distribution is calculated in the event the recovery is not sufficient to pay all treating doctors and/or facilities in full. Once you receive your settlement or verdict proceeds, your attorney will be obligated to withhold and pay the medical provider out of the settlement proceeds.  Failing to do so might subject your attorney to personal liability for the amount owed.

Sometimes clients with health insurance have difficulty finding a physician on their health plan willing to provide treatment if the treatment is in any way connected to an injury related to an automobile or truck accident. I know of several large clinics in the area that refuse to treat anybody, even if you are an existing patient, if the treatment is in connected to an injury sustained in a motor vehicle  accident. Unfortunately some doctors abhor any involvement in the legal aspects of a claim. The reasons are varied. Their practice may focus more on disease or illness with limited experience treating and charting injury claims. Some doctors may feel uncomfortable providing deposition or trial testimony.

At this point some clients with health insurance opt to obtain treatment through the use of a Letter of Protection (LOP). Utilizing a Letter of Protection can provide an injured person a larger choice of physicians. Ultimately this is up to the injured person who must always consider the fact that any treatment obtained through a Letter of Protection will have to be paid to the doctor out of the proceeds of his/her settlement.

If you, a love one or friend have questions about how to pay for medical treatment after a motor vehicle accident I urge you to pick up the phone and give me a call.

 

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